Esophagectomy for cancer in octogenarians: should we do it?

Paulus, Elizabeth; Ripat, Caroline; Koshenkov, Vadim P.; Prescott, Angela T.; Sethi, Kiran; Stuart, Heather; Tiesi, Gregory; Livingstone, Alan S.; Yakoub, Danny

doi:10.1007/s00423-017-1573-x

Cited by 36 publications

(32 citation statements)

References 22 publications

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“…Despite acceptable short-term outcomes, the length of hospital stay was long (mean, 28.1 and 26.0 days in the non-elderly and elderly groups). In Japan, the length of hospital stay tends to be much longer than that in the Western countries because of the difference in social and medical systems [2,5,7,8,19]. Patients typically return home to daily life directly after discharge so that they stay at the hospital until they get substantial recovery, fair oral intake, and removal of all drainage tubes.…”

Section: Discussionmentioning

confidence: 99%

“…Esophageal cancer is the sixth on the list of cancers with the highest mortality rates [1]. Moreover, the increasing general life expectancy leads to a larger number of elderly patients diagnosed as esophageal cancer [2]. Although esophagectomy is still positioned as the cornerstone treatment for esophageal cancer, it is associated with high morbidity and mortality rates for elderly patients despite recent advances in the surgical practice [1,3,4].…”

Section: Introductionmentioning

confidence: 99%

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Feasibility of subtotal esophagectomy with systematic lymphadenectomy in selected elderly patients with esophageal cancer; a propensity score matching analysis

et al. 2019

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Background The global increase in elderly populations is accompanied by an increasing number of candidates for esophagectomy. Here we aimed to determine the postoperative outcomes after subtotal esophagectomy in elderly patients with esophageal cancer. Methods Patients (n = 432) with who underwent curative-intent transthoracic subtotal esophagectomy with 2- or 3-field lymphadenectomies for thoracic esophageal cancer were classified as follows: non-elderly (age < 75 years, n = 373) and elderly (age ≥ 75 years, n = 59) and groups. To balance the essential variables including neoadjuvant treatment and stage of progression, we conducted propensity score analysis, and clinical characteristics, perioperative course and prognosis were compared. Results After two-to-one propensity score matching, 100 and 50 patients were classified in the non-elderly and elderly groups. The elderly group had more comorbidities and lower preoperative cholinesterase activities and prognostic nutrition indexes. Although incidences of postoperative pneumonia, arrhythmia and delirium were slightly increased in the elderly group, no significant differences were observed in overall incidence of postoperative complications, rates of repeat surgery and death caused by surgery, and length of postoperative hospital stay between the two groups. There were no significant differences in disease-free and disease-specific survival as well as overall survival between the two groups. Conclusion Older age (≥75 years) had limited impact on morbidity, disease recurrence, and survival after subtotal esophagectomy. Therefore, age should not prevent older patients from benefitting from surgery.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Feasibility of subtotal esophagectomy with systematic lymphadenectomy in selected elderly patients with esophageal cancer; a propensity score matching analysis

et al. 2019

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“…Several patient characteristics may influence the outcomes following surgery for oesophageal cancer. Older age is a prognostic factor, but its influence has declined with more specialised surgery and is more evident only after the age of 80 years, and rather related to co-morbidities than age itself 160–162. Higher Charlson Co-morbidity Index (which assigns a score based on the presence and severity of 22 comorbid conditions) and previous heart conditions seem to reduce the prognosis after oesophageal cancer surgery, and co-morbidities may also negatively influence the long-term health-related quality of life following oesophagectomy 8,162.…”

Section: Managementmentioning

confidence: 99%

Oesophageal cancer

Smyth

Lagergren

Fitzgerald

et al. 2017

Nat Rev Dis Primers

766

641

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Oesophageal cancer is the sixth most common cause of cancer-related death worldwide and is therefore a major global health challenge. The two major subtypes of oesophageal cancer are oesophageal squamous cell carcinoma (OSCC) and oesophageal adenocarcinoma (OAC), which are epidemiologically and biologically distinct. OSCC accounts for 90% of all cases of oesophageal cancer globally and is highly prevalent in the East, East Africa and South America. OAC is more common in developed countries than in developing countries. Preneoplastic lesions are identifiable for both OSCC and OAC; these are frequently amenable to endoscopic ablative therapies. Most patients with oesophageal cancer require extensive treatment, including chemotherapy, chemoradiotherapy and/or surgical resection. Patients with advanced or metastatic oesophageal cancer are treated with palliative chemotherapy; those who are human epidermal growth factor receptor 2 (HER2)-positive may also benefit from trastuzumab treatment. Immuno-oncology therapies have also shown promising early results in OSCC and OAC. In this Primer, we review state-of-the-art knowledge on the biology and treatment of oesophageal cancer, including screening, endoscopic ablative therapies and emerging molecular targets, and we discuss best practices in chemotherapy, chemoradiotherapy, surgery and the maintenance of patient quality of life.

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“…However, previ-ous reports have shown that elderly patients have similar morbidity and mortality rates than younger patients. [8][9][10] For instance, Ruol et al 9 compared the postoperative outcomes of 159 patients q70 years old and 580 patients <70 years old at a single institution and found that the rates of overall morbidity (49.1% versus 48.6%), in-hospital mortality (1.9% versus 2.7%), and 30-day mortality (1.9% versus 1.9%) were similar in both the groups. Similarly, Paulus et al 10 reported that postoperative morbidity, mortality, and length of stay in octogenarians were comparable to younger patients.…”

Section: Discussionmentioning

confidence: 99%

Influence of Patients' Age in the Utilization of Esophagectomy for Esophageal Adenocarcinoma

Schlottmann

Strassle

Molena

et al. 2019

Journal of Laparoendoscopic & Advanced Surgical Techniques

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Background: The indication of surgical resection in esophageal cancer is often conditioned by patient's age. We aimed to assess the trends in utilization of surgical treatment for esophageal adenocarcinoma (EAC) in the United States, stratified by age groups. Methods: We performed a retrospective analysis of the National Cancer Institute's Surveillance, Epidemiology, and End Results program registry for the period 2004-2014. Adult patients (aged q18 years) diagnosed with EAC were eligible for inclusion. The yearly incidence of esophagectomy, stratified by age groups (18-49, 50-70, and >70 years old), was calculated using Poisson regression. Weighted log-binomial regression was used to compare the proportion of patients undergoing esophagectomy, within each age group. Inverse probability of treatment weights were used to account for potential confounders. Results: A total of 21,301 patients were included. During the study period, the rate of esophagectomy decreased from 34.1% to 28.2% (P = .40) in patients between 18 and 49 years old, from 38.6% to 33.3% (P = .06) in patients between 50 and 70 years old, and from 21.4% to 16.9% (P = .04) in patients older than 70 years. After accounting for patient and cancer characteristics, patients older than 70 years were 50% less likely to undergo esophagectomy compared with both patients between 18 and 49 years old (risk ratio [RR] 0.51, 95% confidence interval [CI] 0.45-0.57, P < .0001) and patients between 50 and 70 years old (RR 0.53, 95% CI 0.50-0.56, P < .0001). Conclusion: Surgical resection is scarcely used in patients older than 70 years in the United States. Further investigation of surgical outcomes in elderly patients is warranted to determine if surgical treatment is underutilized in a large proportion of EAC patients.

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Esophagectomy for cancer in octogenarians: should we do it?

Abstract: Postoperative mortality, morbidity, and length of stay in octogenarians are comparable to younger patients, while the overall survival is worse. With appropriate patient selection, good outcomes can be accomplished in octogenarians undergoing esophagectomy for cancer.

Cited by 36 publications

References 22 publications

Feasibility of subtotal esophagectomy with systematic lymphadenectomy in selected elderly patients with esophageal cancer; a propensity score matching analysis

Feasibility of subtotal esophagectomy with systematic lymphadenectomy in selected elderly patients with esophageal cancer; a propensity score matching analysis

Oesophageal cancer

Influence of Patients' Age in the Utilization of Esophagectomy for Esophageal Adenocarcinoma

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